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1、皮(肌)瓣治疗小腿长段骨坏死实验研究与临床应用厶【摘要】[H的]探讨皮(肌)瓣治疗骨坏死的可行性。[方法]应川新西兰大白兔48只，随机分为对照纟II、实验组。按实验方法将胫件制成廿坏死模型。对照组用游离皮片覆盖坏死件；实验纟II用腓肠肌皮瓣覆盖坏死骨。术后2、4、8、12周行ECT、X线片、骨钙素(BGT)、组织切片检查。临床应用436例。[结果]ECT显示实验组动脉相放射摄入值及延迟相放射摄入值明显高于对照组(P<0.02)；jflL清BGP水平实验组各吋段均比对照组高(PvO.OOl)；组织学检查4周实验组髓腔中可见增生的血管，大量竹细
2、胞；X线片12周实验组的胫前皮质件接近正常骨，而对照组皮质骨仍为坏死、骨质硬化。临床应用小腿外观好，足部肿胀消退，创血感染治愈，坏死骨成活，骨髓腔再通。[结论]用血运丰富的皮(肌)瓣覆盖坏死胫骨段后，血运改善，坏死骨可以成活。【关键词】皮瓣骨坏死实验研究Investigationandclinicalapplicationofcutaneousmuscularflapintreatmentofleglongsegmentalnecrosis//FANQishen,ZHOUXiangji,YINMingjie,etal.Depailmento
3、fOrthopedics,the89thHospitalofPLA,Weifang,Shandong,261021,ChinaAbstract：[Objective]Toinvestigatetheusageofcutaneousmuscularflapinthetreatmentofleglongsegmentalosteonecrosis.[Method]Osteonecrosismodelsoftibiawasmadein48rabbitsanddividedrandomlyintocontrolgoupoftibianecrotic
4、bonecoveredwithfreeskingraftandexperimentedgroupwithcutaneousgastrocnemiusflap.AllofthemwereexaminedwithECT,nidiograph,osteocalcinmeasurementandhistologicalobservationin2,4,8,12weekspostoperatively.Treatmentoftibialongsegmentalnecrosiswithcoveringofcutaneousgastrocnemiusfl
5、apin436patienswerereviewed.[Result]Absorptiveradioactivityinarterio-phaseanddelay-phaseofECTinexperimentalgroupwerehigherthanthoseincontrolgroup(P<0.02),andserumosteocalcinlevelinexperimentalgroupwashigherthanthatincontrolgroup(Pv0・001).Histologicalexaminationat4weekpostop
6、erativelyshowedthatangiohyperplasiaandabundantbonecellsinmedullarycavityoftibiainexperimentalgroupandradiographsat12weekspostoperativelydemonstratedanormalizationofcorticalboneofanteriortibia,whiletibialcoticalbonestillremainednecrosisandsclerosisincontrolgroup.Theclinical
7、resultsof436casestibialongsegmentalnecrosiscoveringwithcultaneous-gastrocnemiusflapsshowedanalmostnormalappearanceofleg,fade-awayoffootswelling,healofinfectionwounds,revivalofbonesequestrumandrecanalizationofmedullarycavity.[Conclusion]Cutaneousgastrocnemiusflaptransplanta
8、tionisaneffectiveandvaluabletreatmentfortibialongsegmentalnecrosiswithadvantageofsupplyin
